Appendix A - Contractor's License Certification Form - Page 1.docx

This is a Contractor's License Certification Form (Appendix A) for RFx 3000025678, a Statewide Emergency Remediation Services solicitation issued by the State of Louisiana. The form requires bidders to provide company information, including company name and address, and to list all required licenses applicable to the work, with corresponding license numbers. Bidders must complete this certification form and submit it with their bid response. The form includes signature lines for an authorized representative or bidder, along with typed or printed name, title, and date fields.

Submission of the completed Contractor's License Certification Form is mandatory, and failure to include this form with the bid will result in bid rejection. The form accommodates up to four license types, with provisions for additional licenses to be listed on separate attached documentation as needed. This licensing requirement ensures that all bidding contractors possess the necessary credentials and regulatory compliance to perform emergency remediation services at the state level.